Thomas Usher played a Brazilian musical instrument and danced while teaching a group of Lexington children capoeria, a martial art that combines acrobatics and dance. He looked like a picture of health.
“I love doing capoeria. I love to dance. I want to pass that on to children,” he said.
Usher’s own childhood was plagued by shortness of breath, coughing spells and fatigue. But it wasn’t until two years ago, at 26, that he learned he had asthma.
“My doctor down in Berea … said, ‘You should have been hospitalized, you should have been hospitalized all your life,’” he said. “And I was like, ‘Well, that’s good to know.’”
For many minorities, chronic diseases often go undiagnosed and untreated — at a rate far higher than their white counterparts. This is not a new problem.
In 1985, the U.S. Department of Health and Human Services released the Heckler Report. It was the agency’s first time conducting a comprehensive examination of the impact of behavioral and societal issues on the health of African-Americans, Hispanics, Asians and Native Americans.
The agency identified six causes of death that accounted for more than 80 percent of fatalities among minorities: cancer, cardiovascular disease and stroke, chemical dependency, diabetes, homicide and accidents, and infant mortality. The report also found that there were 60,000 more deaths among minorities than whites facing the same health circumstances each year.
Dr. Nadine Gracia, director of the Office for Minority Health at the U.S. Department of Health and Human Services, said the Heckler Report was a call to action to end racial health disparities in America. It outlined eight recommendations ranging from patient outreach and education to creating better financial options, conducting research and collecting data in order to address health disparities.
To some degree, the recommendations worked.
Between 1980 and 2010, deaths due to heart disease were cut in half for blacks. The disparities in childhood vaccination rates between white and minority children have nearly closed. And overall cancer deaths among blacks have also decreased.
But despite that progress, the health status of minorities continues to lag behind that of white Americans.
''Race and ethnicity, sex, sexual identity, age, disability, socioeconomic status, geographic location all contribute to an individual’s ability to achieve good health.'' Kentucky Public Health Commissioner Stephanie Mayfield
“The condition that we see now is that minorities are less likely to receive preventive services needed to stay healthy, and that they are more likely to receive a lower quality of care, and therefore experience poor health status,” Gracia said.
Today, black women die from breast cancer at much higher rates than white women, and black men are twice as likely to die from prostate cancer than white men, according to the Office of Minority Health.
The enduring disparities can be attributed to social and economic challenges, such as poverty, lack of education and substandard housing.
And much of the problem can be linked to a lack of health insurance.
Usher said he doesn’t think his mom had the best insurance, if any at all, when he was a child. He only recalls seeing a doctor when it was time for a back-to-school physical exam.
“I’m fairly sure my mom knew I had asthma and everything like that, but we could never really do anything about it,” Usher said. “The best thing I could do was stay in as top shape as possible and not pass out through force of will.”
Kentucky Public Health Commissioner Stephanie Mayfield said that from a statistical standpoint, Usher had several factors working against him, including the fact that he’s African-American, male and grew up in a single-parent home.
“Race and ethnicity, sex, sexual identity, age, disability, socioeconomic status, geographic location all contribute to an individual’s ability to achieve good health,” Mayfield said. “So, if there is a disparity in any one of those factors, there is not equity.”
Disparities in quality and outcomes of care by income, race and ethnicity are large and persistent, and have not been improving substantially, according to the 2014 National Healthcare Quality and Disparities Report, produced by the federal Agency for Healthcare Research and Quality.
The state is trying to address those disparities through a new initiative called kyhealthnow. Gov. Steve Beshear unveiled the effort last year as a strategy to improve the overall health of Kentuckians.
Mayfield said the public health campaign aims to meet seven health goals by 2019, including reducing the state’s smoking, obesity and cancer death rates. It also has the goal of reducing the state’s uninsured rate to less than 5 percent.
Sick & Tired is a four-part web and radio series examining health disparities among racial minorities in Kentucky. It's part of the Next Louisville: Community Health project, a partnership between WFPL News, the Foundation for a Healthy Kentucky and the Community Foundation of Louisville.
Currently, 9.8 percent of Kentuckians don’t have health insurance, according to the Gallup Healthways Well-Being Index. That’s about twice the goal — but it’s progress. Before the Affordable Care Act went into effect in January 2014, 20.4 percent of Kentuckians were uninsured.
Usher is one of more than 500,000 Kentuckians who have enrolled in health insurance through the state’s exchange, Kynect, created under the federal health law.
He said his days of being doubled over wheezing in pain are behind him. But he sometimes wonders what his quality of life would have been had he gotten treatment sooner.
“It made me feel like I wasted a little bit of potential, but it didn’t sadden me or anything,” he said. “I just kept going. I’m going to try to stay in good standing health so I can still be an upstanding citizen … a productive citizen, if you will.”